Considerations for patients awaiting heart transplantation

Area of Science:

• Cardiology
• Transplantation Medicine
• Public Health Policy

Background:

• The German transplant law implementation marked a shift in heart transplantation practices.
• Patient demographics on the heart transplant waiting list have evolved over time.

Purpose of the Study:

• To describe patients on the heart transplant waiting list in Germany.
• To compare outcomes before and after the implementation of the new transplant law.

Main Methods:

• Utilized data from the Eurotransplant registry for patients listed between 1990 and 2009.
• Employed competing risk methodology to calculate actual mortality rates.
• Followed patients until heart transplantation, death, or end of observation.

Main Results:

• The proportion of patients aged 65+ on the waiting list increased significantly from 1.9% in 1990 to 12.6% in 2008.
• The 1-year mortality rate on the waiting list decreased in 2001-2009 compared to 1991-2000.
• The chance of dying before transplantation decreased from 25.9% to 18.9%, while the chance of receiving a transplant within a year dropped from 64.3% to 40.2%.

Conclusions:

• Despite worsening patient profiles and reduced access to transplantation, mortality rates for heart transplant candidates in Germany have decreased.
• These findings suggest improvements in the management of advanced heart disease in Germany.